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Source: Carver PL. Invasive fungal infections. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. Accessed March 14, 2017.




  • Systemic fungal infection.




  • Systemic fungal infection caused by Coccidioides immitis




  • Arthroconidia inhaled after contact with contaminated soil.

  • Transformed into spherules, which reproduce and produce endospores.

  • Endospores released, stimulating acute inflammatory response.

    • Tissue infiltrated by mononuclear cells, resulting in granuloma formation.




  • Coccidioides immitis grows in soil as mold.

  • Endemic regions encompass semiarid areas of southwestern United States from California to Texas, where there is scant annual rainfall, hot summers, and sandy, alkaline soil.




  • No risk factors for primary disease, but factors that affect risk of subsequent dissemination of disease are summarized in Table 1.

Table Graphic Jump Location
TABLE 1.Factors for Severe, Disseminated Infection with Coccidioidomycosis



  • Spectrum of illnesses ranging from primary uncomplicated respiratory tract infection that resolves spontaneously to progressive pulmonary or disseminated infection.

  • 60% of patients asymptomatic; 10- to 30-day incubation period.

  • 40% of patients exhibit nonspecific symptoms that are often indistinguishable from ordinary upper respiratory infections.




  • Nonspecific symptoms that occur within 1–3 weeks after exposure:

    • Fever.

    • Cough.

    • Headache.

    • Sore throat.

    • Myalgias.

    • Fatigue.

    • Fine, diffuse rash may appear during first few days of illness.

  • Chronic, persistent pneumonia or persistent pulmonary coccidioidomycosis (primary disease lasting >6 weeks)

    • Complicated by hemoptysis, pulmonary scarring, and formation of cavities or bronchopleural fistulas.

  • “Valley fever” (25% of patients)

    • Syndrome characterized by erythema nodosum and erythema multiforme of upper trunk and extremities in association with diffuse joint aches or fever.

  • Disseminated infection (<1% of patients)

    • Dissemination may occur to skin, lymph nodes, bone, meninges, spleen, liver, kidney, and adrenal gland.

      • Central nervous system (CNS) infection occurs in ~16% of patients with disseminated infection.

      • Symptoms subtle and nonspecific:

        • Headache.

        • Weakness.

        • Changes in mental status (lethargy and ...

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